Nous Avons Research Articles

Prevalence and causes of hearing impairment in Africa.

To systematically assess the data on the prevalence and causes of hearing impairment in Africa. Systematic review on the prevalence and causes of hearing loss in Africa. We undertook a literature search of seven electronic databases (EMBASE, PubMed, Medline, Global Health, Web of Knowledge, Academic Search Complete and Africa Wide Information) and manually searched bibliographies of included articles. The search was restricted to population-based studies on hearing impairment in Africa. Data were extracted using a standard protocol. We identified 232 articles and included 28 articles in the final analysis. The most common cut-offs used for hearing impairment were 25 and 30 dB HL, but this ranged between 15 and 40 dB HL. For a cut-off of 25 dB, the median was 7.7% for the children- or school-based studies and 17% for population-based studies. For a cut-off of 30 dB HL, the median was 6.6% for the children or school-based studies and 31% for population-based studies. In schools for the deaf, the most common cause of hearing impairment was cryptogenic deafness (50%) followed by infectious causes (43%). In mainstream schools and general population, the most common cause of hearing impairment was middle ear disease (36%), followed by undetermined causes (35%) and cerumen impaction (24%). There are very few population-based studies available to estimate the prevalence of hearing impairment in Africa. Those studies that are available use different cut-offs, making comparison difficult. However, the evidence suggests that the prevalence of hearing impairment is high and that much of it is avoidable or treatable.

Roles and responsibilities in newborn care in four African sites.

ObjectivesTo explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia.MethodsQualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses.ResultsWe found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family.ConclusionInterventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Incidence des conditions de conservation des vins blancs sur leur teneur en composés soufrés volatils

Dans ce travail, nous avons etudie l’incidence de quelques parametres de conservation des vins issus des cepages blancs grecs, Batiki et Rhoditis, sur leur teneur en composes soufres volatils. Il est demontre que le stade du sulfitage des vins nouveaux joue un role important sur la formation de ces substances, ainsi que l’aeration qui entraine leur diminution. De plus, la conservation des vins en barrique ou en cuve, avec les lies ou non, influence d’une maniere differente la teneur des vins en substances soufrees volatiles. Influence of white wine conservation conditions on the levels of volatile sulphur compounds In the present study, the effects of various parameters of white wine conservation on the level of volatile sulphur compounds were examined. Wines from the Greek white cvs Batiki and Rhoditis were fermented. H2S was analysed colorimetrically, the more volatile sulphur compounds by headspace-gas chromatography (GC) coupled with flame photometry detection (FPD) and the less volatile sulphur compounds by liquid extraction-GC/MS. The best time to sulphurize a young wine is 5-6 d after the end of alcoholic fermentation in order to avoid the accumulation of sulphur substances, especially in wines intended to age on lees, Aeration of wine causes a notable decrease of the more volatile sulphur compounds, whereas the diminution is less important for the less volatile sulphur compounds. Furthermore, the amount of volatile sulphur compounds is affected by the conservation of wines in barriques or in stainless tanks, the duration of contact of wine with its lees, as well as the duration of conservation.

Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit.

The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.

P-174 – Prise en charge de l'enfant polytraumatisé en réanimation pédiatrique

Les tentatives de suicide (TS) de l’adolescent représentent une préoccupation importante de santé publique ayant conduit à de nombreux travaux scientifiques, mais peu auprès de jeunes adolescents. Nous avons étudié les caractéristiques épidémiologiques et le devenir psychique sur 1 an des adolescents ayant été admis dans un service d’urgences pédiatriques de Marseille pour une tentative de suicide, grâce à l’existence d’un réseau hôpital–ville en charge de l’organisation de leur suivi. Cinq cent dix-sept adolescents de moins de 15 ans et 3 mois ont été inclus dans l’étude entre octobre 2002 et décembre 2010. Quatre-vingt-six pour cent étaient des filles, moins d’⅓ vivaient chez leurs 2 parents et près de 27 % présentaient des difficultés importantes de scolarisation. Le procédé suicidaire faisait appel à une intoxication médicamenteuse (IM) pour 83,9 % d’entre eux. Quatre-vingt-dix pour cent d’entre eux ont pu être hospitalisés et bénéficier d’une évaluation pédopsychiatrique. Près d’¼ présentaient des éléments dépressifs. À leur sortie de l’hôpital et durant l’année ayant suivi, la prise en charge psychique était optimale pour 35 % et totalement absente pour 21,4 % d’entre eux. Quinze pour cent des adolescents ont fait au moins une récidive pendant l’année d’observation et 2 d’entre eux sont décédés. Ce taux est inférieur à ceux documentés dans les études réalisées auprès d’adolescents de moins de 18 ans. À l’instar de quelques auteurs, nous constatons que les procédures visant à coordonner les professionnels de santé et à améliorer l’accès au soin psychique des jeunes adolescents permettent de diminuer le risque de récidive.Adolescents who attempt suicide are a major concern. A growing body of literature seeks to explain this phenomenon and to identify its predictive factors, but relatively little information is available and children and adolescents under 15 years of age who present to general hospitals because of a suicide attempt. This study aimed to describe the demographic, social, medical, and psychological characteristics of a large sample of 517 French adolescents aged not more than 15 years 3 months. A second purpose was to measure observance of psychological care in a 1-year follow-up. Third, we aimed to document the reattempt rate during the follow-up in this population of young adolescents. Following the French official recommendations, a systematic 72-h hospitalization as well as a somatic, social, and psychological assessment was proposed to every suicide attempter after his or her admission to the emergency department. The adolescent was followed for 1 year after the suicide attempt, called the index episode. This follow-up was organized by two physicians, one of whom was not associated with the care of any of the patients. It consisted in seeking regular information as well as organization and/or optimization of the patient's psychological care, which was delivered in dedicated structures for adolescents, in outpatient care by a psychiatrist, or in an adolescent psychiatric inpatient care unit. In case of a repeated suicide attempt or persistence of alarming symptoms, this follow-up was prolonged for 1 more year. Patient data were compiled by experienced clinicians during initial assessment and alongside the 1-year follow-up through patient self-reports, but also through interviews with informants (family members, social professionals) and clinical sources (general practitioner, psychiatrist, etc.). The areas covered were the characteristics of the index episode, those of the population at the time of the index episode, as well as those of the 1-year follow-up including observance to the care and potential repetition of the suicide attempt. The mean age was 14 years with a minimum of 7 years 9 months. The vast majority of the population was female (86.1%), less than one-third lived with both parents, and 27% had academic problems. The most frequent means of suicide attempt was medication (83.9%), 92.6% of adolescents were hospitalized following the index episode, only 7.5% of them were admitted to adolescent psychiatric unit inpatient care following the initial care. Psychiatric evaluation was documented for 93.3% of the adolescents. Half (n = 222) had at least one symptom of a psychiatric disorder. One-year follow-up data were available for 394 adolescents: 40 had not yet completed the year and 83 were lost to follow-up. Among the analyzable population of 391 adolescents, 35.3% were optimally observant of the care proposed and 21.4% did not observe treatment. Fifty-nine youths (15%) were referred to the hospital because of a repeated suicide attempt. Two of the patients who repeated the suicide attempt within the year had died. The findings from this study are informative with regard to prevention and intervention efforts with suicidal young and very young adolescents. First, repetition of the suicide attempt in young adolescents is not rare since nearly 15% of the cohort were repeaters within the year following the index episode. Nevertheless, intensive care and follow-up resulting in good attendance appeared to have a positive impact on the repetition of the suicide attempt.

Stress, qualité de vie et santé des étudiants. Suivi de cohorte en première année commune d’étude en santé (PACES)

Resume La premiere annee commune des etudes de sante (PACES) est une annee difficile en raison du concours et d’un contexte competitif qui met a rude epreuve la sante des etudiants. Dans le cadre de la reforme des etudes de sante (rentree 2010) qui reunit les quatre filieres (medecine, odontologie, maieutique et pharmacie), un nouveau programme a ete propose en laissant la possibilite aux etudiants de choisir plusieurs concours. Cette reforme qui permet a l’etudiant de redefinir ses choix est apparue comme un nouveau facteur de stress que nous avons voulu evaluer tout en ciblant notre interet sur les consequences physiques et psychologiques de la sante des etudiants et sur leur qualite de vie. Au cours de l’annee universitaire de PACES de 2011–2012, la qualite de vie, le stress et la sante physique et psychologique des etudiants ont ete evalues en debut et en fin d’annee. Les resultats de cette cohorte composee de plus de 1000 etudiants ont montre une qualite de vie des etudiants bien degradee, comparee a d’autres filieres, un stress specifique eleve et des consequences tant physiques que psychologiques qui necessitent de developper des actions preventives aupres de ces jeunes populations qui sont des soignants en devenir.

Association between malaria exposure and Kaposi's sarcoma-associated herpes virus seropositivity in Uganda.

ObjectiveUnlike other herpes viruses, Kaposi's sarcoma-associated herpes virus (KSHV) is not ubiquitous worldwide and is most prevalent in sub-Saharan Africa. The reasons for this are unclear. As part of a wider investigation of factors that facilitate transmission in Uganda, a high prevalence country, we examined the association between antimalaria antibodies and seropositivity against KSHV.MethodsAntibodies against P. falciparum merozoite surface protein (PfMSP)-1, P. falciparum apical membrane antigen (PfAMA)-1 and KSHV antigens (ORF73 and K8.1) were measured in samples from 1164 mothers and 1227 children.ResultsKaposi's sarcoma-associated herpes virus seroprevalence was 69% among mothers and 15% children. Among mothers, KSHV seroprevalence increased with malaria antibody titres: from 60% to 82% and from 54% to 77%, comparing those with the lowest and highest titres for PfMSP-1 and PfAMA-1, respectively (P < 0.0001). Among children, only antibodies to PfAMA-1 were significantly associated with KSHV seropositivity, (P < 0.0001). In both mothers and children, anti-ORF73 antibodies were more strongly associated with malaria antibodies than anti-K8.1 antibodies.ConclusionThe association between malaria exposure and KSHV seropositivity suggests that malaria is a cofactor for KSHV infection or reactivation.

Prevalence of hepatitis C virus in mothers and their children in Malawi.

ObjectivesHepatitis C virus (HCV) prevalence is poorly mapped in the East African region; with the advent of novel HCV therapies, better epidemiological data are required to target the infection. We sought to estimate HCV prevalence in healthy Malawian mothers and assess mother-to-child transmission (MTCT); context is provided by reviewing previously published HCV prevalence data from the region.MethodsUsing ELISA screening and confirmatory blot, serological testing of 418 healthy Malawian mothers for HCV was performed. To examine MTCT, the children of any positive women were also tested for HCV; all children had malignant disease unrelated to hepatocellular carcinoma. We compared our results to published literature on HCV prevalence in Malawi and its neighbouring countries.ResultsThree of 418 women were HCV reactive by ELISA; two were confirmed positive by immunoblot (0.5%). One child of an HCV-infected mother was HCV seropositive. The literature review revealed HCV prevalence ranging from 0 to 7.2% in the region, being highest in Tanzania and specifically for cohorts of inpatients and HIV-co-infected people. The overall estimated prevalence of HCV in Malawi was 1.0% (95%CI 0.7–1.4) when all studies were included (including this one), but lower in healthy cohorts alone at 0.3% (95%CI 0.1–1.2).ConclusionsThis is the first study using confirmatory tests to examine HCV prevalence in healthy Malawian mothers; the prevalence was low. Future studies need to address the source of infection in healthy women.

Promoting the use of science in psychology: A knowledge mobilization model for increasing evidence-based practice.

Decision makers in psychology are increasingly encouraged to know and apply the results of already-existing scholarly research. In a special issue of Canadian Psychology on the use of science in psychology (see Canadian Psychology, vol. 55, issue 3), Dozois et al. (2014) and Tasca, Grenon, Fortin-Langelier, and Chyurlia (2014) described some of the barriers to evidence-based practice centred on the divide between researchers and practitioners in clinical psychology. In order to address some of these barriers, we have developed a community- university partnership in which students are trained to conduct systematic scoping reviews. The scoping reviews provide practitioners with transparent, exhaustive, and nonprescriptive landscapes of existing research relevant to their topics of interest. The performance of the model to date is assessed and recommendations are made for future development.Keywords: evidence-based practice, community-based research, higher education, scoping reviewsResumeLes decideurs en psychologie sont de plus en plus encourages a connaitre et a appliquer les resultats actuels issus de recherches academiques. Dans une edition speciale de Canadian Psychology sur l'utilisation de la science en psychologie (voir Canadian Psychology, vol. 55, numero 3), Dozois et al. (2014) et Tasca, Grenon, Fortin-Langelier et Chyurlia (2014) decrivent certaines des barrieres a la pratique fondee sur les preuves axees sur le fosse existant entre les chercheurs et les praticiens du domaine de la psychologie clinique. Afin de s'attaquer a certaines de ces barrieres, nous avons mis sur pied un partenariat communautaire-universitaire dans lequel les etudiants sont formes pour realiser des examens d'etendue sur une base systematique. Les examens d'etendue fournissent aux praticiens un portrait transparent, exhaustif et non-normatif de la recherche existante selon leurs domaines d'interet. Lerendement de ce modele jusqu'a ce jour y est evalue et des recommandations sont formulees en vue d'une amelioration future.Mots-cles : pratique fondee sur les preuves, recherche communautaire, enseignement superieur, examens de l'etendue.Decision makers in psychology are increasingly encouraged to know and apply the results of already-existing scholarly research (Dozois, 2013). The hope is that evidence-based practice (EBP) will improve care and will save social and mental health services from administering inefficient and ineffective treatments (Sanders, 2010; Spring, 2007). The purpose of this commentary is to supplement some of the strategies relating to increased EBP that are articulated in the articles of Dozois et al. (2014) and Tasca, Grenon, Fortin-Langelier, and Chyurlia (2014) in a recent issue of Canadian Psychology on science in psychology (vol. 55, issue 3).Although EBP is not a new concept in clinical psychology, efforts have been made to understand barriers and to facilitate clinicians' access and use of research findings. The Canadian Psychological Association (CPA) Task Force defines the best available research evidence (Dozois et al., 2014) as that coming from peer-reviewed studies conducted with methods that achieve the highest internal validity. The Task Force wants to encourage practitioners to consider research findings when formulating treatment decisions but it recognizes that access to the findings may be challenging. In harmony with the concerns of the Task Force, Tasca et al. (2014) used the Theory of Planned Behaviour to uncover perceptions of clinicians that may thwart EBP. The results showed that clinicians tend to perceive a significant and functional gulf between those who create research findings and those who are expected to apply those findings. Taken together Dozois et al. (2014) and Tasca et al. (2014) illustrate a spectrum of barriers to EBP.In this commentary we present a knowledge mobilization process (Bloom, 2014) which may in part serve the aims proposed by Dozois et al. …

Aide à la rédaction: recueil des fautes les plus fréquentes enfrançais écrit par Louise Tellier, Benoît Leblanc

Reviews 285 are not sure where to begin, delving into Mooney’s collection of 160 monologues taken from seventeen of Molière’s comedies is a surefire way to be quickly introduced to the playwright’s comedic style and to appreciate the wealth of his work. Mooney’s subtle translation captures the spirit of Molière and allows twenty-first-century students to understand his humor and irony. This book could be integrated at the high school level, as an introduction to French history and culture, or into acting courses. The five-page biography of Molière, from the early to the golden years, will be useful to students learning about seventeenth-century French society and politics in order to understand how the playwright mocked particular features of his contemporaries. With Mooney’s clever explanations, which introduce each play, readers will recognize Molière’s motivations and familiarize themselves with the characters, the plot, and his comic genius. Each monologue is preceded by a short description of the character, as well as the circumstances that led him or her to deliver the long oration. Mooney’s book features five monologues from Les précieuses ridicules, two from Le médecin volant, ten from L’école des maris, thirteen from L’école des femmes, seven from La critique de l’école des femmes, sixteen from Tartuffe, eighteen from Dom Juan, five from Le docteur amoureux, eight from Le médecin malgré lui, twenty from Le misanthrope, nine from L’avare, seven from Monsieur de Pourceaugnac, ten from Le bourgeois gentilhomme, seven from Les fourberies de Scapin, eleven from Les femmes savantes, and ten from Le malade imaginaire. All in all, Mooney’s book is an entertaining way to learn about classical theater and about the work of the most celebrated French playwright. While there is no substitute for reading an entire play in order to fully understand the characters, this collection of classic as well as less famous lines will be a valuable addition to any high school curriculum. It should be noted, however, that despite the quality of Mooney’s translation and the variety of passages and comic styles he presents, his book unfortunately does not feature the original French versions of the monologues written by Molière. Purdue University Calumet Florian Vauléon Tellier, Louise, et Benoît Leblanc. Aide à la rédaction: recueil des fautes les plus fréquentes en français écrit. Trois-Rivières: SMG, 2013. ISBN 978-2-89094-290-5. Pp. 170. $30 Can. Comprised of six sections (Approche méthodologique; Ouvrages de référence; Dictionnaire—Nos fautes et nos très grandes fautes; Exercices; Corrigé des exercices; Annexe—Consignes du sondage) plus a bibliography and index of words and expressions , this guide reflects the authors’ efforts at compiling, via a survey sent to professionals who edit and revise texts, the most frequent errors in written French. Tellier and Leblanc explain what happened when sorting through the survey feedback: “Ainsi, s’est dégagée une liste de problèmes de vocabulaire (anglicismes, archaïsmes, barbarismes, etc.), de grammaire et de ponctuation auxquels nous avons proposé des formes correctes assorties, au besoin, de notes explicatives” (1). As opposed to other French stylistic guides, information provided on common errors is not done in alphabetical order but in order of frequency of the errors, according to the survey conducted with the writing specialists. So that in the section“Dictionnaire,”the most common error—the confusion between “ballade (poème)” and “balade (promenade sans but précis)”(17)—is the first entry; while the contrast of “plus tôt [plus de bonne heure (s’oppose à plus tard)]”and“plutôt (de préférence)”(94) is the last one. It is also in this section that the authors give a concise explanation for each of the 500 identified errors and its correct usage. For example, #244: “Jules est *excessivement gentil/Jules est extrêmement gentil. L’adverbe excessivement s’emploie exclusivement avec des adjectifs à dénotation négative. Ex. René est excessivement hargneux quand il perd au billard”(59). Not to be overlooked are the eleven exercises.While the first three are the standard ones that...

Données inédites sur le Gravettien oriental : apport de la technologie osseuse à la caractérisation des occupations de Kostienki 4 (Alexandrovska, région de Voronej, Russie)

Le Gravettien oriental est encore trop souvent réduit à sa manifestation la plus spectaculaire : la «culture de Kostienki-Avdeevo » . Certains sites ont pourtant livré des industries lithiques qui s’en démarquent très nettement. C’est le cas du gisement de Kostienki 4 auquel nous consacrons cette étude. Ce site a livré deux occupations généralement rapportées au Gravettien lato sensu, et prenant place entre 21000 et 23000 uncal. BP. L’ancienneté des fouilles, autant que l’absence d’études archéozoologiques rendent la documentation disponible souvent parcellaire. En confrontant, pour la première fois, les données inédites de l’industrie en matières dures d’origine animale de Kostienki 4, aux autres sphères de la culture matérielle, nous avons pu mettre en évidence de nouveaux éléments de caractérisation de ses deux phases d’occupation. Nous verrons que ce sont des groupes indubitablement différents qui s’y sont succédés, et probablement à différentes saisons de l’année. Des différences majeures transparaissent dans les matières osseuses exploitées, dans leur transformation et leur utilisation, questionnant sur la pertinence d’un rattachement de ces deux niveaux d’occupation à une même entité culturelle. Enfin, les différences observées entre les deux habitats du niveau inférieur, nous permettront de discuter d’une éventuelle différentiation fonctionnelle ou sociale de l’espace.

The Pont Neuf: A Paris View by Johan Barthold Jongkind Reconsidered

<i>The Pont Neuf</i>: A Paris View by Johan Barthold Jongkind Reconsidered

Technology-savvy career counselling.

Career concerns are often mentioned by clients seeking not only career counselling, but also mental health counselling. Typically, these career concerns fall into 2 main categories: career decision making and job-search needs. Technology, in the form of websites, social media, and applications, has expanded the resources available to today';s counsellors. We explored multiple technological tools that might accompany each step of the career decision-making process, organized through the lens of cognitive information processing theory, as well as the job-search process. Regardless of the professional identity or primary focus of counselling services provided by the counsellor, having knowledge of career-counselling websites, tools and strategies such as those presented in this paper will ensure that clients are equipped with the tools necessary to address their career concerns.Keywords: technology, career counselling, social media, apps, telepsychologyResumeLes preoccupations en matiere de carriere sont souvent mentionnees par les clients desirant recourir a des services d'orientation de carriere mais aussi par ceux qui recherchent de l'aide en sante mentale. Generalement, ces preoccupations en matiere de carriere se divisent en deux grandes categories : la prise de decisions relatives a la carriere et les besoins en matiere de recherche d'emploi. La technologie, qu'elle soit sous forme de sites web, de medias sociaux ou d'applications, a considerablement augmente le nombre de ressources a la disposition des conseillers en orientation d'aujourd'hui. Nous avons explore de nombreux outils technologiques susceptibles d'accompagner chacune des etapes du processus de prise de decision, tant dans la perspective du traitement cognitif de l'information que du processus de recherche d'emploi. Peu importe l'identite professionnelle ou le principal objectif des services d'orientation fournis par le conseiller en orientation, le simple fait d'etre au courant des sites web, outils et strategies en matiere d'orientation de carriere abordes dans le present article, permettra d'assurer que les clients soient adequatement outilles pour repondre a leur preoccupations en matiere de carriere.Mots-cles: technologie, orientation de carriere, medias sociaux, applications, telepsychologie.According to the U.S. Bureau of Labor Statistics (2013) (http:// www.bls.gov/tus/charts/), Canadians spend an average of 36.6 hours at work each week (see also Employment and Social Development Canada, 2014; http://www4.hrsdc.gc.ca/.3ndic.1t.4r@eng.jsp?iid = 19). Similarly, Americans spend the majority of an average day (8.8 hours) working (sleeping came in second at 7.7 hours). With the majority of our waking time being spent at work, it is no wonder that career-related issues are often woven into conversations with mental health practitioners, even when the presenting concern is not career-related. Thus, having knowledge and skills to help clients with their career issues is essential.Today';s advances in technology have moved beyond websites to social media (SM) tools such as blogs, applications (apps,) and social networking tools that offer new ways of assessment and providing information. These tools create opportunities for psychologists to enhance service delivery and to connect with clients outside of the traditional office setting. In addition, Gati and Asulin-Peretz (2011) suggested that it is important for career practitioners to increase the use of technology in the careercounselling process. In this manuscript, we aimed to review literature, present technologies relevant to career decision-making and job searching, provide ideas for how technology can be used to enhance and extend the service delivery of psychologists, and identify and address some of the challenges in using technology in counselling. But first, we turn our attention to career issues commonly experienced by clients.Career Issues Commonly Experienced by ClientsThe National Career Development Association (2009b) identifies six key areas that are typically addressed during career counselling: learning about self, obtaining occupational and educational information, enhancing decision-making and career planning, coping with career challenges and transition issues, conducting a job search, and applying for training and further education. …

Integration of diagnosis and treatment of sleeping sickness in primary healthcare facilities in the Democratic Republic of the Congo.

Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo (DRC) has always been a vertical programme, although attempts at integration in general health services were made in recent years. Now that HAT prevalence is declining, the integration question becomes even more crucial. We studied the level of attainment of integration of HAT case detection and management in primary care centres in two high-prevalence districts in the province of Bandundu, DRC. We visited all 43 first-line health centres of Mushie and Kwamouth districts, conducted structured interviews and inspected facilities using a standardised checklist. We focused on: availability of well trained staff - besides HAT, we also tested for knowledge on tuberculosis; availability of equipment, consumables and supplies; and utilisation of the services. All health centres were operating but most were poorly equipped, and attendance rates were very low. We observed a median of 14 outpatient consultations per facility (IQR 8-21) in the week prior to our visit, that is two patients per day. The staff had good knowledge on presenting symptoms, diagnosis and treatment of both HAT and tuberculosis. Nine centres were accredited by the national programme as HAT diagnosis and treatment centres, but the most sensitive diagnostic confirmation test, the mini-anion exchange centrifugation technique (mAECT), was not present in any. Although all nine were performing the CATT screening test, only two had the required cold chain in working order. In these high-prevalence districts in DRC, staff is well-acquainted with HAT but lack the tools required for an adequate diagnostic procedure. Attendance rates of these primary care centres are extremely low, making timely recognition of a resurgence of HAT unlikely in the current state of affairs.

Investigation of antimalarial activity, cytotoxicity and action mechanism of piperazine derivatives of betulinic acid.

To semisynthesise piperazine derivatives of betulinic acid to evaluate antimalarial activity, cytotoxicity and action mechanism. The new derivatives were evaluated against the CQ-sensitive Plasmodium falciparum 3D7 strain by flow cytometry (FC) using YOYO-1 as stain. Cytotoxicity of 4a and 4b was performed with HEK293T cells for 24 and 48 h by MTT assay. The capability of compound 4a to modulate Ca(2+) in the trophozoite stage was investigated. The trophozoites were stained with Fluo4-AM and analysed by spectrofluorimetry. Effect on mitochondrial membrane potential (ΔΨm) was tested for 4a by FC with DiOC6 (3) as stain. For β-haematin assay, 4a was incubated for 24 h with reagents such as haemin, and the fluorescence was measured by FlexStation at an absorbance of 405 nm. Antimalarial activity of 4a and 4b was IC50 = 1 and 4 μm, respectively. Compound 4a displayed cytotoxicity with IC50 = 69 and 29 μm for 24 and 48 h, respectively, and 4b was not cytotoxic at the tested concentrations. Addition of 4a leads to an increase in cytosolic Ca(2+) . We have measured ΔΨm after treating parasites with the compound. Data on Figure 4a show that mitochondria were not affected. The action mechanism for 4a, inhibition of β-haematin formation (17%), was lower than CQ treatment (83%; IC50 = 3 mm). Compound 4a showed excellent antimalarial activity, and its action mechanism is involved in Ca(2+) pathway(s).

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities.

To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. Between August 2008 and February 2009, a cross-sectional study was conducted among all (245) smear-positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower- and middle-income quintiles (adjusted odd ratio (aOR) = 36.2, 95% CI [12.3-106.3] and aOR = 6.4 [2.8-14.6]), adverse pre-diagnosis stage (aOR = 5.4 [2.2-13.3]) and less education (aOR = 4.1[1.9-8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). Catastrophic direct costs and substantial indirect and coping costs may persist under the 'free' tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.

Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the ‘healthy migrant effect’ hypothesis

The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.

Faut-il hospitaliser les patients suicidants avec trouble de personnalité borderline après leur prise en charge aux urgences (étude prospective FRENCH CRISIS) ?

Le trouble de personnalité borderline (TPB) se définit notamment par l’instabilité des relations interpersonnelles et de l’image de soi, ainsi que l’impulsivité des sujets qui en souffrent. Certains auteurs soutiennent que l’hospitalisation de ces patients ne réduit pas leurs comportements suicidaires et pourrait leur être délétère (régression ou renforcement des comportements auto-agressifs). Pour déterminer si l’orientation hospitalière des patients suicidants à haut risque de TPB au décours des urgences influence les récidives des comportements suicidaires à 6 mois, nous avons utilisé les données de l’étude prospective multicentrique FRENCH CRISIS. Le risque de présence d’un TPB a été évalué par un autoquestionnaire de dépistage, le PDQ-4+. Nous avons mesuré la récurrence des comportements suicidaires à 6 mois dans le groupe des patients hospitalisés et celui des non-hospitalisés. Trois cent vingt sujets ont été inclus et répartis entre un groupe ayant un risque élevé d’avoir au moins un TPB ( n = 197), un groupe ayant un risque élevé d’avoir au moins un TP non TPB ( n = 84) et un groupe ayant un faible risque d’avoir un TP ( n = 39). L’hospitalisation au décours des urgences n’est pas associée à une différence de récidive des comportements suicidaires à 6 mois entre les groupes. Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. There is a high prevalence of BPD patients among those admitted to the emergency department for suicide attempts. However, little empirical research exists to assist clinicians in deciding whether to hospitalize a suicidal patient. Some authors have argued that hospitalization does not prevent suicide and could actually harm these patients, thereby leading to psychosocial regression. Parasuicidal behaviors could be reinforced by the attention given during hospitalization. Our purpose was to determine whether the hospitalization of suicidal patients who have a high risk of BPD after discharge from the emergency department is associated with a recurrence of suicidal behavior at 6 months. We designed a prospective study, acquiring patients from three emergency hospitals. The participants were suicidal subjects admitted for voluntary drug intoxication and were 18 years of age or older. The participants completed the Personality Disorder Questionnaire (PDQ-4+) to assess BPD symptomatology. Information on the recurrence of suicidal behavior at 6 months was obtained by interview of patients and the review of the charts from the 3 hospitals involved in the study. Other assessments included the BDI-13 (severity of depression), the Hopelessness Scale (hopelessness), the TAS-20 (alexythymia), the AUDIT (alcohol disorder) and the MINI (axis I disorders). A total of 606 subjects admitted for a suicide attempt participated in this study. A total of 320 (52.8 %) of the subjects completed the PDQ-4+. The sample was divided into three groups: participants at high risk of having at least one BPD ( n = 197), a group at high risk of having at least one non-BPD PD ( n = 84) and a group with low risk of having a PD ( n = 39). Hospitalization following an emergency was not associated with a recurrence of suicide attempts at 6 months among patients at high risk of BPD. A logistical regression analysis showed pre-hospitalization antidepressant prescription to be associated with recidivism (OR = 2.1, P = .037). Our exploratory study suggests that hospitalization may not increase suicide attempts among patients with BPD when the health organization does not include a specific device such as DBT.

The practice and clinical implications of tablet splitting in international health

ObjectiveTablet splitting is frequently performed to facilitate correct dosing, but the practice and implications in low-income settings have rarely been discussed.MethodsWe selected eight drugs, with narrow therapeutic indices or critical dosages, frequently divided in the Lao PDR (Laos). These were split, by common techniques used in Laos, by four nurses and four laypersons. The mean percentage deviation from the theoretical expected weight and weight loss of divided tablets/capsules were recorded.ResultsFive of eight study drugs failed, on splitting, to meet European Pharmacopoeia recommendations for tablet weight deviation from the expected weight of tablet/capsule halves with 10% deviating by more than 25%. There was a significant difference in splitting accuracy between nurses and laypersons (P = 0.027). Coated and unscored tablets were less accurately split than uncoated (P = 0.03 and 0.0019 for each half) and scored (0.0001 for both halves) tablets.ConclusionThese findings have potential clinical implications on treatment outcome and the development of antimicrobial resistance. Investment by drug companies in a wider range of dosage units, particularly for narrow therapeutic index and critical dosage medicines, is strongly recommended.